Tuesday, May 29, 2012

The next in our Best of the Month series is from December 16, 2011:Now that it's winter and our noses and sinuses are being dried out by
our heating systems, many of us turn to neti pots (also known as 'nose
bidets'). The illustrious J. Clay Goodman, MD, neuropathologist at Baylor, just sent me an article from The Houston Chronicle
warning people to use distilled, bottled, or boiled water. Officials in
Louisiana are investigating whether a 51-year-old woman and a
20-year-old man both contracted the brain-eating amoeba Naegleria fowleri after using tap water in their neti pots. The disease, while rare, is most commonly contracted after inhaling
water from a lake, pond or river. If investigators confirm the two
victims died after using tap water from a neti pot it will be the first
time the disease has been contracted from tap water.

Update on May 29, 2012: A comment was left in the original post suggesting that the water used in the two deaths may have resulted from the use of well water, not tap water. I was unable to confirm that contention in an internet search on the topic. All the news sources I consulted state that the water was indeed tap water.

Thursday, May 24, 2012

CurePSP is an organization dedicated to raising public awareness of progressive supranuclear palsy (PSP). A member of the board of CurePSP, Justin Shea, is currently taking his parents on a tour of baseball parks throughout the nation in an effort to raise public awareness and funds for PSP. Justin, whose father was diagnosed with PSP in March of 2009, is documenting the family's journey with a blog. Justin writes: "[S]ince my Dad's
diagnosis, we have been able to raise both awareness and considerable
funds to help researchers find a cure... Collectively, we have raised
over $30,000. We have decided to continue these efforts throughout the
country by visiting every MLB park."

Monday, May 14, 2012

We neuropathologists, and society as a whole, has spent a lot of time over the last couple of years rethinking the long-term effects brain damage causes by repeated concussive and subconcussive blows to the heads of professional and college football players. But what about the 3.5 million kids in American who play below the high school level? Dr. Peter Cummings today sent me a link to a report regarding groundbreaking research being done at Virginia Tech in which impact-measurement instruments were placed on 7 and 8-year-old football players. Data was collected on more than 750 hits to the head over the course of the season.

Lead researcher, Stefan Duma, a professor of Biomedical Engineering, reports that some head impacts
in youth football are equal in force to some of the bigger hits he sees at
the college level. The average kid received 107 head impacts during the course of the season. This is few than seen in high school (which averages about 500 per season) and college (which amounts to about 1000 per season.). But what about the magnitude of these hits? The median impact was 15 g's. In Duma's study, there were 38 impacts that were 40 g or greater (almost all of which occurred during practice.) Six impacts were over 80 g's, which starts to get into the range of risk for concussion. “Nobody expected to see hits of this magnitude,” says
Duma, who speculates that once players start seeing hits of 30 g's above, there is a risk for cumulative injury.

Here's the video report from reporter Stone Philips. The interviews with the parents of these youth players perplexed me. All of the parents featured found the results concerning, but none expressed any thoughts about having their child switch to another sport.

Friday, May 4, 2012

On rare occasion, I stray from this blog's focus on clinical neuropathology to inform readers about new innovations in education. After all, we neuropathologists, almost by definition, are educators. I would therefore like to introduce a new direction in higher education that may indeed change the world. I am talking about edX, a joint venture between Harvard and MIT that will offer online learning to millions of people around the world for free. Anyone with an internet connection, whether you are a shopkeeper in Bangalore or a teenager in Modesto, will soon be able to take graded courses at MIT and Harvard while engaging with other online students and interacting with professors. MIT launched the prototype for this new innovation this spring with a course called "Circuits and Electronics". About 120,000 individuals worldwide registered for this single course -- a number approaching the total number of living MIT alumni! Anant Agarwal, MIT’s Director of the Computer Science and
Artificial Intelligence Laboratory and new President of edX, had this to say about this new venture: “Online
education for students around the world will be the next big thing in
education. This is the single biggest change in education since the printing
press.”

At this point, no degrees will be granted, but students will receive certificates verifying completion of a course.

At the press conference announcing the launch of edX, Harvard Provost Alan Garber said: “We believe in not only producing educational courses
online, but using this as literally an unprecedented opportunity to examine
fundamental questions about how we learn. This is not only about how to design
the best online courses. This is about learning how to use the classroom more
effectively… It’s enabling us to ask very different questions than we’ve typically
asked before. For example, we need not only ask how will our students do on an
exam, we can begin to ask questions about how well they acquire and apply the
information months after the course has ended… This is a platform that will
enable us to do research that simply hasn’t been possible before.”

There no doubt that this new endeavor will change the face of education, democratizing and radically diffusing knowledge and intellectual discourse. EdX is the beginning of a new way of teaching and a new way of learning, and the change will extend to medical education, including neuropathology education. This should be interesting.....

Thursday, May 3, 2012

The next in our "Best Post of the Month" series is from November 18, 2011:

Over 1400 attendees at 2011 SNO meeting in Anaheim

Dr. Aldape discussed brain tumor biomarkers

Same view as above, at 40X

Neuropathology took center stage at the Society for Neuro-Oncology (SNO) meeting today as Dr. Kenneth D. Aldape,
neuropathogist at the University of Texas MD Anderson Cancer, was
introduced as the next president of the society. Dr. Aldape also
delivered an address to more than 1400 attendees about the future of
surgical neuropathological reporting. Aldape's research centers on the
clinical utility of brain tumor biomarkers as prognostic indicators. He
described how the use of biomarkers will change the way surgical
neuropathology diagnoses are rendered. He noted that the broad
morphologic spectrum one sees in gliomas makes the recommendations of
the World Health Organization sometimes difficult to implement. For
example, the difference between a WHO grade II and grade III astrocytoma
is based principally on whether or not mitotic figures are "brisk" as
interpreted by the examining neuropathologist. Yet, the imprecision of
that approach is obvious when one considers variables such as the
diligence of the neuropathologist in identifying mitotic figures, the
often equivocal morphology of apoptotic-versus-mitotic cells, as well as
the variable technical quality of tissue processing and staining. The
use of biomarkers will make diagnoses more reliable and will provide
more useful prognostic information to the oncologist. Dr. Aldape
projected onto the screen an example of a recent surgical
pathology report he had generated at MD
Anderson. The report highlighted the status of the several biomarkers,
including G-CIMP, IDH1, pHH3, MIB1, 1p/19q deletion, and MGMT. Then,
only in the
last sentence of the comment, was it noted that the histology and
biomarker profile was most consistent with a WHO grade III (anaplastic)
astrocytoma. It was as if the WHO diagnosis and grade were a perfunctory
afterthought. Finally, Aldape noted that biomarkers will become even
more important in the coming years as biomarker data becomes
"actionable", allowing the oncologist to personalize the treatment of a
particular tumor depending on the biomarker profile. These are exciting
times....